Cardiac Pacemakers in Pediatric Heart Transplant Recipients: Incidence, Indications, and Associated Factors

Abstract

This study was undertaken to assess the incidence, indications, and predisposing factors for pacemaker placement in a pediatric heart transplant population. From November 1985 to May 1994, 246 pediatric patients have undergone cardiac transplantation at Loma Linda University Medical Center. Seven (2.8%) have received pacemaker placement with an 8-50 month follow-up period. Median age at transplant was 462 days (0 days to 2.5 years). The median time to pacemaker placement was 190 days (18-1,672 days) after transplantation. Indications were sick sinus syndrome (SSS) in 5 and heart block in 2 patients (1 during acute rejection). Three patients with SSS underwent electrophysiology studies (EPS); 1 was normal and 2 showed sinus node dysfunction. The mode of pacing was VVIR in 6 patients and VVI in 1 patient. All 6 survivors are doing well and 5 patients' pacemakers still provide support. These 7 patients were compared with 185 pediatric patients (0 days to 12-years-old) transplanted during 1985 through 1993 who survived at least 6 months after transplantation. There was no correlation between the receipt of a pacemaker and graft cold ischemic time, rejection history, donor age, or recipient age at transplantation. The 5 patients with SSS had significantly lower average heart rates in the first month after transplantation (108 +/- 16 vs 130 +/- 12; P = 0.0002). The need for permanent pacemakers in this population is uncommon. Pacemakers, however, can be safely performed when necessary with excellent clinical results.

Pacemaker implantation in pediatric heart transplant recipients: Predictors, outcomes, and impact on survival

“…Cannon et al 5 found that 2 of 106 pediatric patients (1.9%) required PPM placement within 3 months. Similarly, Chinnock et al 6 reported that only 1 of 246 infants (0.41%) who underwent HTx during the study period required PPM implantation within 3 months, comparable to our finding. Interestingly, PPM implantation in our study also was lower than that reported in adults, which has been about 10.9%.…”

“…5,6 he incidence of bradyarrhythmias requiring pacemaker placement in the pediatric population has been variably reported at 2.8% to 6.6%. 5,6 Given the lack of reliable data in the pediatric population, we sought to investigate the incidence, predictors, and outcomes associated with acute need for PPM placement after pediatric HTx using a large national registry.…”

Late Onset Paroxysmal AV Block after Transplantation

“…2 In addition, PAVB has been reported secondary to catheter related injury and contrast angiography in the cardiac catheterization laboratory. 9 In addition, Cannon et al reported one case of high-grade AV block out of 106 pediatric transplant patients. [5][6][7][8] There are few cases in the literature of PAVB in pediatric patients late after cardiac transplant.…”

Postoperative Care of the Transplanted Patient

“…Post-transplant sinus node dysfunction is common with a reported prevalence as high as 44% [12] and is likely related to myocardial ischemia and surgical manipulation [13] [14]. Due to diastolic dysfunction and impaired filling of the transplanted heart, atrio-ventricular (AV) synchrony and adequate heart rate are often required to maintain cardiac output.…”

“…Although sinus node dysfunction is typically transient [12], some patients will have permanent sinus node dysfunction and require permanent pacing. A 2-5% prevalence of pacemaker placement has been reported with sick sinus syndrome and complete heart block constituting the most common indications [14] [15]. …”